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What would you do - Ethical dillemma

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  • What would you do - Ethical dillemma

    A few days ago chap comes in with Rx for scheriproct suppositories.

    Hand written at the very top of the Rx was the words proctosedyl (which I found out was the doctors way of prescribing an alternative if he had problems getting the scheriproct)

    At the time we couldnt get either suppository from wholesalers.

    He was well vexed to start with as he'd been to a few Pharmacies already and they were having the same supply problem as we were - 'Who'd be ill in this country' he said

    I told him that both were unavailable at present and stupidly said that we even had a box of scheriproct that had gone out of date (I probably said it to try and stress the fact that we very rarely give out either suppository anyway without the supply problem and to stop him shouting at me)

    Anyway he looks at me and says give me them then. The scheriproct had been written off about three weeks earlier (so roughly about 7 weeks passed EXP date) and were in the yellow bins awaiting destruction.

    Question is: How many of you would have supplied the out of date suppositories in the interest of the patient and the current supply problem and how many would have refused to supply out of date meds ?

  • #2
    Re: What would you do - Ethical dillemma

    I wouldn't have given them to him, not worth the risk. If anything untoward like microbial contamination(unlikely, I know) had affected the suppositories, its your neck!

    I would have referred back to Dr. with the details of an alternative I could get.

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    • #3
      Re: What would you do - Ethical dillemma

      Don't be intimidated,this is usually the type of chancer who would try and "smear it" in your face.
      Stand your ground, just say NO.

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      • #4
        Re: What would you do - Ethical dillemma

        bottom line: never supply a medicine/product out of date, EVEN IF the patient insists on having it, also if a patient brings along an old med to ask about it, aways check the expiry date. Alot of things are still ok way past their expiry date but as a healthcare professional advising theur use would be negligent, as you could not be sure of their safety or efficay e.g. bacterial contamination as mentioned above
        We are the music makers, We are the dreamers of dreams and God damn we are that good

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        • #5
          Re: What would you do - Ethical dillemma

          'Alot of things are still ok way past their expiry date'
          is there a way to find out which drugs are still active past the ED?
          plus does taking expired medications results in adverse reaction on your health state ( assuming you are a HEALTHY person with no medical conditions)? i always thought that once the product is expired, the drug is no longer active i.e inactive drugs should not have any adverse effects.

          perhaps someone would enlighten me
          cheers in advance
          [COLOR=Olive]xxxx They tried to break my back, but i survived. whatever doesn't kill you, will only makes you stronger xxxx
          [/COLOR]

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          • #6
            Re: What would you do - Ethical dillemma

            Originally posted by Raoul View Post
            'Alot of things are still ok way past their expiry date'
            is there a way to find out which drugs are still active past the ED?
            plus does taking expired medications results in adverse reaction on your health state ( assuming you are a HEALTHY person with no medical conditions)? i always thought that once the product is expired, the drug is no longer active i.e inactive drugs should not have any adverse effects.

            perhaps someone would enlighten me
            cheers in advance

            well either you do pharmaceutical analysis on the med which is going to tae ages and not worth the cost or the time, or you could take it. It's easier with things like creams and ointments because they actually show signs of "cracking" if they are unusuable.

            So say if the expiry on the ointment says Feb 2008, will it still be ok on the 28th of Feb, what about 1st March,? 15th of March? I've got an epaderm ointment that expired a few motnhs ago but still is of the same consistancy, colour, smell etc... so i'l use it for a few motnhs more unless I feel it has gone past it's actuall date of expiry. My opinion however on expired tablets would be totally different.

            Also about effects of expired meds, well you dont really know, some tablets might be safe while others will be not, e.g. toxic products of degradation.
            We are the music makers, We are the dreamers of dreams and God damn we are that good

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            • #7
              Re: What would you do - Ethical dillemma

              Not much of a dilemma, really, is it? Find me 5 pharmacists who'd have given him the out of date stock and I'll show my bum in Boots' window.

              It might have been different a few years ago, but nowadays? Really? Would any pharmacist put themselves at risk like that?

              I personally don't believe that 7-week date-expired Scheriproct would have done him any harm at all, but the harm to my career if it got back to the Society/the PCT/the Daily Mail/the police means it really *isn't* worth taking the risk for, in the interests of the patient or not.

              Comment


              • #8
                Re: What would you do - Ethical dillemma

                Originally posted by Raoul View Post
                i always thought that once the product is expired, the drug is no longer active i.e inactive drugs should not have any adverse effects.

                perhaps someone would enlighten me
                cheers in advance
                I like torches (see candlepowerforums) too so i'll handle enlightenment

                The expiry date is the date at which the manufacturer is certain that the active amount of medicine remaining in each dose is still within the allowable +- limits for that medicine, assuming storage conditions have been followed at all times.

                After that date they will no longer guarantee (sp?) that the dose contains +-% of the active drug.

                So there will be some (in fact usually most) of the active drug remaining after
                expiry.

                Also, some delivery systems breakdown with time (eg imagine epilim slllllooooowwwllly getting water in through the packaging).

                Whether there is sufficient active drug to have a therapuetic effect becomes questionable depending on the medicine.

                Also, IIRC, some medicines have poisonous breakdown products (tho I can't remember any examples off hand......) so you'd best be sure it's not one of those before handing them out....
                Employed again... paid holidays! Yipee

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                • #9
                  Re: What would you do - Ethical dillemma

                  Just sell him some Anusol HC and have done with it. Its not like he's dying
                  I cant believe you are all naval grazing about this. The fact is its illegal to dispense out of date meds. And although they are thinking about lifting this restriction in the event of a flu pandemic, grapes dont really qualify.
                  MUR

                  Major Underestimation of Resources

                  Comment


                  • #10
                    Re: What would you do - Ethical dillemma

                    Originally posted by Part Timer View Post
                    Not much of a dilemma, really, is it? Find me 5 pharmacists who'd have given him the out of date stock and I'll show my bum in Boots' window.
                    An enhanced service?
                    MUR

                    Major Underestimation of Resources

                    Comment


                    • #11
                      Re: What would you do - Ethical dillemma

                      Find me 5 pharmacists who'd have given him the out of date stock and I'll show my bum in Boots' window.
                      gives a new meaning to the saying "turning the other cheek"
                      We are the music makers, We are the dreamers of dreams and God damn we are that good

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                      • #12
                        Re: What would you do - Ethical dillemma

                        Nice one guys.

                        Well as it terns out I didnt supply them but after he left the shop I just wondered how many would have supplied.

                        Right! Turn this on its head:

                        The patient now has terminal cancer (not the same patient, this is a theoretical patient. I dont wish this on the suppository chap) and has just been released for the hospice to die at home with family.

                        The out of date meds with the supply problem are diamorphine amps.

                        No Pharmacy in the area can get the amps, no one has any stock but you have a few out of date amps awiating destruction.

                        a) Do you supply, knowing the meds are out of date but acted in the interest of the patient even though the supply could end you in front of a judge?

                        b) Do you refuse to supply, as you know its wrong to supply out of date meds, the patient will have to cope as best she can with an alternative in their last hours?

                        Answers on a post card!!

                        Comment


                        • #13
                          Re: What would you do - Ethical dillemma

                          Originally posted by Mr Pharm S View Post

                          The out of date meds with the supply problem are diamorphine amps.

                          No Pharmacy in the area can get the amps, no one has any stock but you have a few out of date amps awiating destruction.
                          i wouldn't touch it with a barge pole - out of date amps - theres the chance of contamination in an injection there - far too risky and much potential for serious harm there.

                          Firstly, check with pct to see if there's a 'just in case' type system for pharmacies in the pct and see if there's a list - there may be ones you haven't contacted on there who have an agreed minimum stock of certain CDs.
                          Secondly, have a look around and see if there's an alternative suitable for use (eg different strength and a dosage adjustment, or other suitable opiate) and have a word with the prescriber.
                          Thirdly, check with nurse team / local hospitals / the hospice / gp surgery to see if they have any in stock (eg for doctor's bag, ward stock etc) that you could requisition for use.
                          “It's not worth doing something unless you were doing something that someone, somewhere, would much rather you weren't doing.”

                          Terry Pratchett

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                          • #14
                            Re: What would you do - Ethical dillemma

                            how about going to one of the junkeys and asking them to hand over a bag of heroin when they come in for their meth, or maybe ask them where they get their supplies from? they are obviously doing better than we are when there is a supply problem !!!
                            The other alternative is to get an all expenses paid holiday to Afghanistan and harvest the poppies and make your own.
                            Seriously though I would try the PCT then the hospitals, how do shortages of these essential items happen?
                            Why are we responsible for events we really have no control over, another nail in our professionl standing. Surely if the suppliers were policed like we are they would never run out of anything as they could be sued for negligence. just a thought
                            peace and love to you all
                            jammy

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                            • #15
                              Re: What would you do - Ethical dillemma

                              what is the dilemma here, there are so many alternatives that the most that needs to be done is point out an alternative, theres patches, tablets, and amps all in different strenghts, worse comes to worse increase the DHC to max dose iv, and watever else to add on as an adjunct.
                              We are the music makers, We are the dreamers of dreams and God damn we are that good

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